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DOI: 10.1055/a-1841-6419
Abszesstonsillektomie: Uni- oder bilateral?
Abscesstonsillectomy: Uni- or bilateral?Zusammenfassung
Hintergrund Zusätzlich zu einer empirischen Antibiotikagabe kommt als Therapie eines Peritonsillarabszesses (PTA) neben der Drainage von Pus auch die Abszesstonsillektomie (ABTE) infrage. Die Nachblutung nach ABTE ist eine gefürchtete Komplikation und kann in seltenen Fällen bis zum Tod des Patienten führen. Ziel dieser Studie war der Vergleich von ABTEs mit und ohne kontralaterale Tonsillektomie (TE) bezüglich Blutungskomplikationen. Zusätzlich wurde das Auftreten von metachronen PTAs auf der Gegenseite untersucht.
Material und Methoden Retrospektive Studie von n=655 Patient*innen, die im Zeitraum von 2004 bis 2019 eine ABTE mit oder ohne kontralaterale TE erhielten. Die operationspflichtigen Nachblutungen wurden in Abhängigkeit von demografischen und chirurgischen Parametern untersucht. Des Weiteren wurde evaluiert, wie häufig es nach unilateraler ABTE zu einem PTA mit Notwendigkeit einer ABTE der kontralateralen Seite kommt.
Ergebnisse Insgesamt kam es bei 10/655 (1,5%) zu einer operationsbedürftigen Nachblutung. Bei 404/655 wurde eine ABTE mit kontralateraler TE durchgeführt. Hier zeigte sich bei 8/404 (1,98%) die Blutung kontra- oder bilateral. Nur 2 Patient*innen (2/251, 0,7%) mit unilateraler ABTE bluteten nach. Die Nachblutungsrate nach unilateraler ABTE war signifikant niedriger als bei ABTE mit kontralateraler TE (0,7% vs. 1,98%; p=0,001). Bei 0,8% der Patient*innen erfolgte bei metachronem PTA eine ABTE der Gegenseite.
Schlussfolgerungen Insgesamt zeigte sich die Nachblutungsrate nach ABTE mit 1,5% gering. Die Nachblutungsrate nach unilateraler ABTE war signifikant geringer als nach ABTE mit kontralateraler TE. Daher sollte die Indikation zur kontralateralen TE bei unilateralem PTA streng gestellt werden.
Abstract
Objective In addition to an empirical use of antibiotics for treatment of a peritonsillar abscess (PTA) there is a drainage of pus or the abscess tonsillectomy. Postoperative bleeding after abscesstonsillectomy (ABTE) is this surgery’s most feared complication which can rarely lead to patients’ deaths. The objective of this study was to compare bleeding complications of ABTE with and without contralateral tonsillectomy (TE) and to analyze the occurrence of a metachronous PTA at the contralateral side.
Methods Retrospective study of n= 655 patients undergoing ABTE with and without TE of the contralateral side from 2004 to 2019. Bleeding complications needing surgical hemostasis were analyzed regarding demographic and surgical parameters. In addition, occurrence of PTA and need for ABTE of the contralateral side after unilateral ABTE were evaluated.
Results Overall, 10/655 (1.5 %) patients presented with postoperative bleeding after ABTE. In 404/655 an ABTE with contralateral TE was performed. Here, 8/404 (1.98 %) patients showed contra- or bilateral bleeding. Only in 2/251 (0.7 %) patients occurred a bleeding complication after unilateral ABTE. Therefore, bleeding after unilateral ABTE was significantly lower than ABTE with contralateral TE (1.98 % vs. 0.7 %, p= 0.001). In 0.8 % of the patients a contralateral ABTE was necessary due to a metachronous PTA.
Conclusion Overall, the rate of postoperative bleeding after ABTE (1.5 %) was low. Unilateral ABTE showed significantly lower postoperative bleeding rates compared to ABTE with contralateral TE. Consequently, the indication of a contralateral TE must be very strict.
Schlüsselwörter
Abszesstonsillektomie - Nachblutung - Peritonsillarabszess - Tonsillektomie - postoperative KomplikationKeywords
unilateral - bleeding complication - peritonsillar abscess - tonsillectomy - abscess tonsillectomyPublication History
Received: 14 November 2021
Accepted after revision: 29 April 2022
Article published online:
23 May 2022
© 2022. Thieme. All rights reserved.
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